What is the treatment for burning neuropathy in the foot caused by a herniated intervertebral disc (slipped disc)?

From the Guidelines

Treatment for burning neuropathy in the foot caused by a herniated intervertebral disc should start with gabapentin (300-900mg three times daily) or pregabalin (75-150mg twice daily), as these medications have shown efficacy in treating neuropathic pain, including pain caused by nerve root compression 1. The goal of treatment is to alleviate pain, improve quality of life, and minimize morbidity and mortality.

• The initial approach should involve a combination of pharmacological and non-pharmacological interventions, including physical therapy, topical treatments, and lifestyle modifications.
• According to the Mayo Clinic Proceedings, the pharmacological treatment of neuropathic pain should follow a step-wise approach, starting with first-line medications such as gabapentin, pregabalin, or duloxetine 1.
• The use of opioids should be reserved for second-line treatment, as recommended by the International Association for the Study of Pain (IASP) consensus panel 1.
• Epidural steroid injections may be considered for patients who do not respond to conservative treatments, as they can help reduce inflammation around the compressed nerve.
• Surgical intervention may be necessary in severe cases that do not respond to other approaches, to decompress the affected nerve and alleviate pain.
• It is essential to monitor patients closely and adjust treatment plans as needed to minimize adverse effects and optimize outcomes.
• The treatment plan should be individualized, taking into account the patient's medical history, comorbidities, and lifestyle, to ensure the best possible outcome and minimize morbidity and mortality.

From the Research

Treatment Options for Burning Neuropathy in the Foot

• The treatment for burning neuropathy in the foot caused by a herniated intervertebral disc (slipped disc) can include various pharmacologic and non-pharmacologic interventions 2, 3, 4, 5, 6.
• Pharmacologic treatments may include:
  • First-line treatments: pregabalin, gabapentin, duloxetine, and amitriptyline 3, 5.
  • Second-line treatments: topical capsaicin and lidocaine 3, 5.
  • Third-line treatments: opioids, botulinum toxin, and cannabinoids 3, 5.
• Non-pharmacologic treatments may include:
  • Physical therapy, such as McKenzie physiotherapy 6.
  • Transforaminal epidural injections 6.
  • Surgical options, such as discectomy, may be considered in severe cases 2.

Efficacy of Treatment Options

• Studies have shown that these treatment options can be effective in reducing pain and improving quality of life in patients with neuropathic pain 2, 3, 4, 5, 6.
• A combined nonsurgical management approach, including McKenzie physiotherapy, gabapentin, and periradicular injections, has been shown to be effective in reducing pain and improving function in patients with sciatica due to lumbar disc herniation 6.
• The efficacy of these treatment options may vary depending on the individual patient and the specific cause of their neuropathic pain 2, 3, 4, 5.